Health Emergencies in Large Populations

1. Health Emergencies in Large Populations (HELP) By Apollo Musa (PHO) and Emily Nyanumba (Physiotherapy)

2. THE HELP COURSE • What are the most effective means to protect the lives and dignity, and promote the health, of people affected by major disasters or armed conflicts? • What must be done to analyse a complex crisis, evaluate needs, assess the resources available and set priorities? • What goes into planning and managing a response and, later, evaluating its effectiveness? • How should threats to public health be prevented or responded to, mental and social well-being promoted, and care provided in a way that is effective, sustainable, respectful and ethically sound?

3. THE HELP COURSE…. Noun • a direction or route taken or to be taken. • the path, route, or channel along which anything moves. • advance or progression in a particular direction; forward or onward movement. • the continuous passage or progress through time or a succession of stages. • the track, ground, water, etc., on which a race is run, sailed, etc. • a particular manner of proceeding • a customary manner of procedure; regular or natural order of events.

4. OUTLINE • HELP – Health Emergencies in Large Populations – • is a course on the provision of humanitarian assistance during disasters, armed conflicts and other complex crises. It was created in 1986 by the International Committee of the Red Cross (ICRC), in partnership with the World Health Organization (WHO) and the University of Geneva, to professionalize the delivery of humanitarian assistance during emergencies, and to promote professional ethics and humanitarian principles.

5. SCOPE • The course seeks to develop the knowledge and skills, and the approach – based on scientific evidence, best practices and professional ethics – • That humanitarian personnel need in order to take decisions that are effective, to ensure that their conduct is never less than humane and to adapt their activities as needed. • The HELP course contributes to raising technical and ethical standards for humanitarian work, and to fostering collaboration between the academic and humanitarian worlds. • Because of its public health approach, the course is of pertinence to a broad range of professionals, including medical personnel, operational managers, technicians, logisticians, lawyers, policymakers and leaders of humanitarian organizations.

6. OBJECTIVES • At the end of the course, participants should be able to make effective and ethical decisions in humanitarian crises. More specifically, they should be able to: • describe the essential public-health, healthcare, management, legal and ethical issues associated with humanitarian action, and the methods of dealing with them; • analyse health and other humanitarian needs using a multidisciplinary approach that takes into account the perceptions, vulnerabilities and capabilities of the people affected; • plan and manage, and subsequently evaluate, activities in response to major humanitarian crises; • address complex situations by means of an integrated approach that takes into account the needs and capabilities of individuals and groups, as well as the resources available to them, and that is based on measures for protecting individual and public health, international humanitarian law, human rights and professional ethics.

7. CONTENT • The course explores the principles underlying the provision of humanitarian assistance in health emergencies and major health crises, and the methods of providing such assistance. • It begins with a consideration of certain key concepts: public-health tools, humanitarian principles, professional ethics, and effective decision-making in crises. • After that, various aspects of health emergencies are examined: • health care, nutrition, economic security, water and habitat, environmental health, prevention and control of communicable diseases, epidemiology in the field, mental health, sexual violence, the safety of humanitarian workers and the stresses to which they are subject, and the imperatives of humanitarian law.

8. CONTENT…… • Depending on the local context and current events, other topics may also be addressed: • first aid in the field, war surgery, management of dead bodies, response to nuclear, radiological, biological or chemical threats, pandemics, protection of medical personnel, facilities and vehicles during crises, health needs of women, children and other vulnerable groups, and so on. • The course prepares the ground for organizations involved in disaster management to take roughly the same approach, and thus also helps to improve coordination among them during emergencies.

9. A JOINT EFFORT • The course is organized by the ICRC in partnership with academic institutions, the WHO, National Red Cross and Red Crescent Societies and other institutions involved in relief operations. • At present, HELP course partners include: • In Nairobi, Kenya: • The Jomo Kenyatta University of Agriculture and Technology • The Kenya Red Cross Society

10. OVERVIEW OF THE COURSE • HEALTH AND HUMANITARIAN NEEDS IN CRISES • An effective humanitarian response focuses on the people affected and is based on sound ethical principles. • It takes an integrated approach to tackling health issues – the physical and mental health of individuals and public health; assessments and responses address the health and dignity of people and their basic physical needs, and emphasize preventive care, curative care and rehabilitation.

11. PLANNING AND EVALUATION • A public-health approach, such as the one taken by the HELP course, is fully equipped to assess needs, contexts and resources, define priorities, and plan and evaluate activities. • The course explores, by means of case studies and simulation exercises, some of the most common challenges encountered during emergencies, such as clinical triage and setting priorities for public health.

12. ETHICS IN HUMANITARIAN ACTION • Respecting all persons affected and protecting their lives and dignity and life are core duties in any relief operation. • During disasters and armed conflict, humanitarian personnel are often confronted by difficult, and sometimes extremely delicate, ethical situations. • To be able to take and implement sound decisions in response to a situation of crisis, they must-have a strong commitment to and respect for ethics and humanitarian principles, and must be equally dedicated to ensuring equity, gender sensitivity and respect for fundamental rights. • They must also be aware of the possibility of having to confront ethical dilemmas and of the need for a structured and ethical decision-taking process.

13. NUTRITION AND ECONOMIC SECURITY • Malnutrition, lack of regular income and economic insecurity are serious and complex problems, and very common in emergencies. • They are major threats to people’s lives. • The course addresses a number of matters in this regard: nutritional assessments, the restoration of economic security, and methodological guidelines for planning, implementing and monitoring activities in connection with general and specific food-aid operations (to tackle malnutrition, for instance) and feeding centres.

14. ENVIRONMENTAL HEALTH • Human beings cannot survive without water. • Ensuring access to adequate supplies of safe water is an absolute priority in any emergency response. • Poor hygiene, overcrowding and vectors of disease can have lethal consequences during emergencies. • The course looks into the impact of environmental conditions and the availability of water on public health. • Basic methods of providing emergency water supply, black water treatment, garbage disposal, vector control, emergency shelter and energy supply are also explored.

15. COMMUNICABLE DISEASE CONTROL • Controlling communicable diseases is particularly important during disasters, especially when large concentrations of people are living in unsanitary conditions. • Outbreak preparedness and early-warning systems for detecting such diseases – as well as methods of investigating and responding to them – will be discussed.

16. EPIDEMIOLOGY • Epidemiology is an essential tool in relief operations. • During an emergency, the results of the initial needs assessment, the monitoring of assistance activities, and the evaluation of the impact of relief operations must all be documented. • The course will cover basic methods of collecting and analysing data, with a view to enabling participants to set up and use an effective health information system, and to understand and respond as needed to health-related data.

17. HEALTH-CARE SERVICES • Disasters and other crises create a great demand for medical and surgical care, and often for emergency treatment. • Existing health services may be overwhelmed, and may need various kinds of support, such as expertise in different branches of medicine. • Forestalling threats to public health and preventing illnesses are key components of health services in emergencies. • These activities should be incorporated in the medical services provided to people affected. • Special consideration must be given to vulnerable groups such as women and children. • Meeting reproductive health needs and managing childhood illnesses or chronic diseases are among the major challenges that have to be dealt with during crises.

18. MENTAL HEALTH AND PSYCHOSOCIALSUPPORT • The mental-health consequences of crises, and mental-health needs, are now recognized as priorities during disasters and armed conflict. • These needs must be addressed in a professional and structured manner, and the course will help participants learn to do so.

19. HEALTH SYSTEMS • Health services in emergencies encompass primary health care, pre-hospital and emergency care, hospital care and specialized services, such as mental-health care and rehabilitation services. • All these components – which include community-based services and the international relief response –make up a comprehensive health system. • During the course, special attention is given to examining the interaction of these components, to identifying key requirements for improving the functioning of health systems in emergencies, and to the provision of support to existing health-care services – because all this is crucial for ensuring the sustainability of health services after a crisis.

20. INTERNATIONAL HUMANITARIAN LAW • This is the branch of international law that regulates armed conflict. • It protects people who are not, or who are no longer, involved in the fighting, and restricts the means and methods of warfare employed. • Everyone involved in humanitarian work has a duty to understand its basic principles, and to incorporate these principles in all humanitarian activities and broaden awareness of them.

21. PROTECTION OF PEOPLE AFFECTED • Any relief activity, regardless of the circumstances, must ensure legal protection for those who are affected. • Promoting respect for these people, ensuring their safety from threats and attacks, and preventing discrimination against them are essential components of any response to a crisis.

22. PROTECTION OF HEALTH-CARE STAFFAND MEDICAL SERVICES • During disasters or armed conflict, wounded or sick people and medical workers and facilities are at risk, directly or indirectly. • They may be subjected to threats or attacks; and sometimes, people may be killed and facilities destroyed. • The basic norms of humanitarian law and human rights law, and the fundamental humanitarian and ethical principles that govern the provision of health care, are vital elements of any health or humanitarian response in emergencies. • Everyone involved in humanitarian work must know, respect and spread awareness of these rules and principles.

23. SAFETY AND WELL-BEING OF HUMANITARIAN PERSONNEL • Humanitarian personnel have a duty to ensure their safety and that of their colleagues in the field. • They must be able to deal with stress and ensure the well-being of others as well.

24. COORDINATION OF HUMANITARIANRESPONSE • Professionals involved in relief operations must know how the humanitarian response to a crisis is organized and coordinated. • In most situations of the kind, many agencies, working at local, national and international levels, are involved. • Coordination mechanisms are essential for ensuring that the immediate needs of all those affected are covered.

25. TEACHING APPROACHES AND METHODS • The course emphasizes problem solving and participatory teaching and learning: analysis of situations and group discussions are key elements. • Various teaching methods are used: • lectures by experts, selected readings, group • work in problem solving, simulations of disasters, field visits, and presentations by the participants themselves. • In some places, distance-learning modules allow participants to prepare for or supplement the residential course.

26. PARTICIPANTS • The course is intended for professionals involved in humanitarian action, who have field experience and hold positions of responsibility in humanitarian operations, particularly the following: • health professionals, such as doctors, nurses or nutritionists; public health officers and epidemiologists – water and environment engineers, legal or policy advisers, and people with strategic and managerial responsibilities. • Candidates working in countries affected by humanitarian crises are given special consideration.